In the World of the High Tech Redneck, the Graybeard is the old guy who earned his gray by making all the mistakes, and then tries to keep the young 'uns from repeating them. Silicon Graybeard is my term for an old hardware engineer; a circuit designer. Here are mental droppings from a newly retired radio engineer running from tech news to economics; from firearms to the world at large; from radio to home machine shops and making all kinds of stuff.

Thursday, November 29, 2012

Obamacare Rolls Into My Life

It's no secret I'm an old guy - Graybeard is a description, not something I made up. For those of you who don't know, the protocol for prescribing statins for control of cholesterol make it virtually automatic that every guy over 50 is going to get them. Why? You get them if you have two risk factors: you get one risk factor for being male and another for being over 50. Therefore, if you cross 50 and get set up for a cholesterol test, you'll get put on statins. Now, if you have a cholesterol "issue" of some kind and you're 40, you get put on them: one risk factor for the test, the other for being a dude.

Let me pause here for a quick point: if you think that it's unanimously agreed that high cholesterol is a problem, or that the usefulness of cholesterol-lowering drugs has been absolutely proven, or that there is no controversy at all associated with this, you need to read more. It's a side point here, but you can start at THINCS. You need to read Dr. Duane Graveline, MD, former NASA astronaut, or Track Your Plaque. Yeah, you're going to find the typical internet sniping, with everyone calling each other idiots, but that's my point: there is real controversy here.

I've been on statins, with short breaks, since I was 40 and I'm starting to show liver damage. Not enough for my doc to say get off them, but enough that we're looking closely at it. There's a pair of liver enzymes they measure and mine are running at about 2x normal and have been for a couple of years now. I figure if I burn out my liver and need a transplant in 10 years, the Glorious Peoples' Ministry of Health will deny it and offer me a juicer instead of a transplant, so I'd prefer to get off the statins. Yesterday I went to the doc, talked about some extra tests to run along with other options and agreed on some things to do. He tells me, "there is no perfect option here".

Then he started talking to me about what's coming after the first of the year. He said he hired some advisers to consult on his practice, and they told him that with his current business model and the coming Obamacare changes, he goes bankrupt within a year. No way out. Because of this, he's dropping his practice and going into the new field of Concierge Medicine. Under this model, I pay him a flat fee of about $1500 for the year and get whatever care I want. While they'll continue to take insurance, and I still need it (as it was originally intended - for unexpected things), I'm supposed to get anything I need from him for that one price.

Unfortunately, with the coming of Obamacare, this is the new thing. According to one of the providers in this arena, around 85% of practicing doctors are looking into getting out of the vise that Obamacare puts them into. In rough numbers, my doctors has 4000 patients and will cut that down to 400. That means 3600 people have to find a new doctor - which he'll help with, but if that's widespread around the area, there's an instant and severe shortage of doctors. He becomes a contractor to - not employee of - a new company that provides these services around the country. Cue Tom Baugh about starving monkeys. Most doctors doing this say they make a little less, but have much less stress and get to work with patients more - which is why they went into Health care in the first place: they care. He says under their plan you get 30 minutes of his time per visit. Current medical economics says 7 1/2 minutes. Sounds like he'll have a ton of more time with 400 patients over the course of a year.

So the brave new world of Obamacare is here in smaller town America. My doc agrees with my assessment of what is coming should I need a liver, and maintains medical care in the country has just been killed off. Personally, I don't think this model of care will survive either, because the whiners are already talking about how "the rich" get this fancy care on demand and everyone else has to sit in a DMV-style line. Fact is, it's already the case in virtually every country with a national health service that the well-off get what they want, even if they have to leave the country to get it. That's as predictable - and unavoidable - as our summer rains.

33 comments:

We have had some serious mis-diagnosis here, advising surgery, serious pharmaceuticals & c, with traditional western medicine. The issues have been resolved (years ago) with homeopathy & chiro - the take away is to consider other options.

Been resisting the call for statins for a long time - the call from the doc that is, who despite being a fantastic doc (himself on statins & niacin) has had four major heart incidents. As you discovered the cure (disease management via pharma) is at least as bad as the boogeyman of a potential heart attack.

What has worked fabulously for me - lose weight - even if it is only 10-15 lbs - exercise - do it. My numbers dropped from realm of concern to what it was in my 20's - really, really low.

Diet seems to be much less of a factor (assuming REAL food) than the nutricrats would have one believe, although alcohol consumption does appear to significantly increase cholesterol, yet statistically (& perversely) reduces incidents of heart problems - in absence of other factors.

Anyway, the dr-patient-money relationship is something I've long pondered. The concierge approach seemed to have real promise, but what happens when you need a specialist? Or tests that "we don't do that here"? Or, for travelers out of area?

One problem IMO is insurance. The expectations of the insured that everything under the sun will be covered, and the disconnect from cost drives up one side, while medical facilities need to be large to play drive up costs on the other side.

However, the biggest problem BY FAR is government involvement in health care - from deciding who may be a doc, how they may practice and where (hospitals & c) the very involvement of government ensures a market disruption and mis-allocation of resources.

I could talk to a lot of this, but "... but what happens when you need a specialist? Or tests that "we don't do that here"? Or, for travelers out of area?" is central to what bothers me about this arrangement.

I do see a specialist, 2 in fact, and if I had to isolate the one thing that I think is going to be a real concern in the next few years, it would be I'm working on needing a hip replacement - a third specialist. My GP can't do that. I don't want my hip done now, but it might not be available in a few years. I might not be able to get that done when I need it.

My doc is a family medicine/sports medicine guy. I've seen him twice this year, once because they called me in (I think that's just building business) and this visit. Not worth $1500!

If you go on a low carb/paleo diet (there are many flavors here) Your ldl numbers should go down, you hdl numbers should rise and your triglycerides should plummet. This should be enough to get you off of the statins.

One of the biggest issues that I see for a lot of us older folks are the medications we will need to continue functioning at anything close to our current level of activity. I use chiro for my back, but with arthritis and three discs already bad, I need my Cox-2 NSAID and my non-narcotic pain medicine to be able to stand or walk. Having a concierge physician will allow me to keep getting meds, ones which work for me, instead of regular NSAIDs that cause severe gastric pain and reflux.

As itor indicated, such a doctor will only be able to provide health maintenance and perhaps some simple remedies for infections, metabolic disorders, etc. that are treatable via medication. Anything else will require insurance, but may simply not be available even then. Those of us who are retired and "non-productive" will not be able to access dialysis, chemo or radiation therapy for cancer, major surgeries, and such.

Knowing how the Marxists and socialists who currently run this country work, I imagine they will pretty quickly shut the door on paying for such things out of pocket - as they have in Canada, where you have to leave the country to get better (or, in some cases, any) care.

Where will we go? Canada and Mexico are out (believe me, you do NOT want to go to Mexico for medical care). SiG could probably afford to go to the DR, where care is cheap and fairly competent, but I won't be able to afford to fly either there or Brazil, so I'll be SOL.

You should check out the documentery "Fathead". Watched it with my fiance, did some double checking on the stuff presented in it, and changed our diet. She was borderline hypoglycemic, no she no longer has reactions to carbs (jittery like shes on drugs). Im only 29 but i feel better tan i can ever remember. I wont go into detail here on the movie but you should at least check it out. I will say my blood pressure dropped quite a bit after the diet change. When the goverment promotes a certain diet to its people with no basis in fact and shoddy research then you know someething is wrong. And its been going on for more than half a century. The guy makes a very good case.Sean.

Diet is part of it (fake-foods, excessive fructose-149 lbs of sugar per year AVERAGE which means someone is eating my unused 100 pounds, grain-fed grass-eaters, and insufficient hydration), excessive pharma intake, alcohol, lack of exercise, genetics (including expression of what you got based on pre-natal experience) is part of it, and then there is stress of the modern life.

I know some smug heavy sedentary vegans who drive hybrid cars, with myriad health "issues" in their 30's, not least that they can't run a quarter mile without an ambulance waiting for them. Vegetarian-Yoga people seem like moderate reasonable people in Portland Oregon.

Don't forget remove the Iodine /Iodide and substitute Bromides everywhere you go and boom cholesterol goes through the ROOF. Old style doctors knew the First sign of High Cholesterol and they checked the thyroid.Now doctors know everything and just manage the illness.

Oh yea and murdered my mother because the Govt. did not want her addicted.

My Cholesterol was almost 300 and the good one not worth mentioning.

After 40 years of telling them my Thyroid is not right , Natural Dessicated Thyroid boom dropped to 220 with in 2 months.The Body uses cholesterol for life, when the Thyroid is inefficient you die slowly , weaken get dumber( or shall I say Stupid) and I made my point.

I came over from "The Smallest Minority", and a few minutes later added you to my blog list. Interesting Info, that from your doctor.I'm evidently in a similar postion, retired, heart problems, and on statins and blood thinners. (1 heart attack, two stinting sessions).On the subject of Heart care, I have dropped 20 lbs, and would like to drop 10 more. I eat very heart healthy, low salt, very low fat intake, etc. (I have for years). I also take fish oil, garlic, and Cayenne supplements. My heart Doc, say's my blockage is hereditary and there is nothing I can do about it.Your doc's vision of the future makes me wonder where I'll come out in this mess.

$1500/year to get personal medical care from the doctor you want sounds like a good deal, especially for someone who needs frequent consultations or continuing care.

I have a question, though. Does this fee cover just that one specialist's services? You note that "He becomes a contractor to - not employee of - a new company that provides these services around the country." Is your fee paid to that company so that you can have access to several different doctors in their pool for that one fee? Or would a person need to pay a $1500 fee to each and every doctor they need? My elderly mother had a rheumatologist, a neurologist, an internist, and other specialists as the occasion required. $1500 annual fees for each different specialist would be out of the question for many Americans.

I'm hearing that many doctors are refusing to take on new patients. So would someone who is healthy now (who uses medical services not at all) be able to enter a concierge relationship in the future? If these doctors are keeping only 10% of their former patient load, and if other doctors are following through on their threat to quit the practice of medicine, then will new patients even be able to find concierge medical services available to them?

I also believe that a thinking person would avoid younger doctors who have not been trained in the traditional ethical standards all Western doctors used to learn -- not to mention the general decline in moral and cultural values that has cheapened respect for and the value of individual life. An older doctor would still know and (to the extent the modern laws allow) respect those standards. New docs, not so much.

Anon 1343 - thanks for your input - I really wish I could answer more of it, but I'll answer what I can.

First, yeah, that $1500/year is for one doctor, and he's a Family Practitioner. For example, this year I saw him twice: one time he called me in - state law says they need to see you once a year if you have prescriptions from a doc - the other time was this visit to talk over lab results. Just to make sure I'm not just getting flow chart medicine.

I see an allergist, but now that the shots are over, I just see him once a year for the same state-driven visit. And that's about it. I have no idea what he plans. Maybe I ought to schedule a visit.

My insurance costs around $200/month, $2400/year, and I still need insurance for the unexpected. Then there's this: AFAIK, my wife is the same cost as me, so add $3000 to that. My wife saw him twice, as well, so $3000/year for four visits? I don't think so.

Beyond this, I can only speculate. I've heard that many doctors are not seeing new patients; the doctor the story is about stopped seeing new Medicare patients last year. If this move to drop the number of patients they see to 10% of the current number, there will be a lot of people looking for a doctor.

I would add to your last paragraph about older vs. younger doctors that doctors have always tended to be very industrious. Self-starters. Until recently with the advent of HMOs and health care corporations, they were all small businesses. The kind of people who work for a government job are security seekers and that's the opposite of the small business owner.

So when 85% of current doctors quit, or are forced out, and the nationwide campaign to get warm bodies into the medical schools plays out, you'll be left with less-qualified doctors who are more like the clerks at the DMV or the Food Stamps office: just putting in their time. There have been stories of British doctors walking out on patients during surgery because it was lunch time. That's what we'll have.

Thanks for your reply (so speedy, too!). It's a very discouraging situation, and I find it hard to make any kind of rational decision in an irrational environment.

I last saw a doctor more than 20 years ago, when I needed surgery for a huge ovarian cyst (thought I was just getting fat). I will turn 62 next month. I am in good health (seldom even have a cold), and I don't intend to see a doctor until I really need one. By then (years from now I hope), the supply and quality of doctors and hospitals will likely be stinkin' and the rules will limit care for people my age (or age-to-be). So I don't expect much, and what I do expect is frightening.

Many decades ago, when I was handed my very first paycheck, I had to ask someone what FICA meant. My immediate thought then was that I would never see a penny in benefits. The older I get, the closer they move the collapse date to my age. People say we get what we deserve. Well, I never voted for any of this crap and did my best to push against it (my mother stuffed envelopes for Barry Goldwater -- and I helped!). Looks like I am going to get stuck with what OTHER people deserve. So why do conservative/libertarian/constitutional types get, as Marilyn said in "Some Like it Hot" the fuzzy end of the lollipop, when we deserve to be rewarded? I am not looking forward to the rest of my life with serenity at all.

Thanks for your reply (so speedy, too!) I'm sitting around smoking a pork butt (which, strangely, is actually the shoulder), so I have more free time than usual today.

My immediate thought then was that I would never see a penny in benefits. You're sounding like me! Sometime in the late 70s, when I realized how SS worked, I became sure I'd never see much worthwhile out of it. I started saving as much as I could, but never really thought the government would deliberately destroy responsible peoples' savings by inflation. I never thought they'd let seniors die instead of spending responsibly. Silly me.

"You're sounding like me!"I take that as a great compliment1 I've been reading your blog for nearly a year but have never commented before. Next time I might emerge even further from my shell and use one of my fake names instead of posting anonymously.

Did some googling and found a local medical concierge group with a good website. I will call them tomorrow to see what kind of package and pricing they can offer. I don't really want to use any medical services now; I just want to line up a relationship that I can count on when the inevitable need arises.

So thanks again for reporting your medical concierge foray. I hope to apply what I've learned from you and to acquire some optimism about the future.

Next up: Tackling the TOR Project. I've read all your posts on the subject and am eager to start figuring out how to use this cool tool. As the tangled-tongue Al Sharpton said, "resist we much" (http://www.examiner.com/article/resist-we-much-named-top-quote-of-2011).

Enjoy your dinner -- by strange coincidence, I will also be eating ham tonight!

Well don't be a stranger and hang around for a year without chiming in again!

On the TOR project, I understand TAILS just released 0.15. I need to set up with that. I've concluded my 4 GB USB sticks are too small to do what I want to do with it, but 32s and 64s are cheap enough...

I'm still an employee of a major company, not a 1099 contractor, so I don't have as much choice in this as I'd like. In particular, we just had our benefits options for calendar 2013 frozen, and I'm stuck with my insurance as is. If this had come up earlier, I might have had different options.

I have a family curse from my Father's side of natural liver created high cholesterol. A diet of bread and water leaves me operating on a total level of about 600+. So a Statin (Lipitor) is necessary and works for me so that I am at a level arount 100 +/-. Several years ago I was on a different Statin that quit working for me giving me some badly clogged arteries and a totally clogged Stent that cannot be reopened. My Doc called me when he got the results of the usual 6 month tests and had me take them again as he could not believe how high the results were. Lipitor knocked thing s back down although not before much damage had been done to me. Right now my cardiac Doc has me taking a reduced dose of Lipitor to see if 40 mg rather than 80 mg will keep me under control (as well as reduce the potential for liver damage). Just took the blood test this AM and do not know the results yet. BTW, my sister has the same problem as does her son and daughter. My son (age 40) is now on Lipitor also as diet and exersize has been futile. I am 75 and have been fighting this for the last 40 plus years taking a variety of different drugs over the years with varying results (Atromid, Questran, Zocor, etc)

I never meant to imply that statins don't have their place. You seem to have FH - familial hypercholesterolemia - which can be treated with it.

I've also read they're very over-prescribed, and for someone like me who has never had a heart attack, and just has a genetically low HDL, their usefulness is very questionable. (Similarly, my son, at 31 has the same lipid profile I have)

Remember, the key liver-cleansing/protecting herb is milk thistle. Get the bottle, see the max dosage and take that when you go to bed- the liver starts to cleanse itself between 12 midnite ad 3 AM, thus giving the max benefits. - This advice from a naturalist.Also, Dandelion, as an herb, helps w/ liver also.

You should look into the Weston Price Foundation and the research published/made available therein on diet and its effects on health (www.westonaprice.org), especially regarding the consumption of nutritious fats (short answer; eat lots of 'em) and their effect on health, endocrine function and cholesterol.

It's a great resource for almost any nutritional question that you can think of!

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Retired radio engineer, follower of Christ, RF designer, mentor. Radio ham, home shop machinist, lapidary, silversmith, roadie cyclist, learning to be a rifleman, and home defender, - a guy with too many interests to keep track of.

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